Cholera: One year later

Posted on October 24, 2011

“What we're calling for, a year into the epidemic, is a prompt integration of prevention, care, and treatment measures,” said PIH co-founder Dr. Paul Farmer – including a pilot program to vaccinate 100,000 Haitians, set to take place in January 2012.

Nearly a half million cases of cholera have been reported in Haiti in the past year – roughly 5 percent of the Caribbean nation’s population. 6,600 Haitians have died since the outbreak began, more than the total number of cholera deaths reported in the rest of the world combined in 2010.

As the bacteria continues to contaminate the lakes, rivers and canals that millions of people use each day for drinking, cooking and bathing, cholera is not going away. Heavy rains and tropical storms also continue to trigger spikes in cholera cases and deaths.

“We don’t know when this epidemic will end,” added Farmer. “It’s going to be with us for a long time,” adding that at some point the disease will become endemic in Haiti.

Farmer and PIH have been advocating for a comprehensive long-term response, including providing chlorinated water at the household and village level, introducing hand washing and hygiene measures, building water and sanitation systems, improving case-finding and treatment and integrating an oral cholera vaccine into PIH’s comprehensive plan.

Efforts on the ground as epidemic enters its second year

As the epidemic moves into its second year, PIH is continuing to support a dozen cholera treatment units throughout central Haiti and Port-au-Prince. Since the start of the outbreak, PIH facilities have seen over 75,000 cases of cholera, according to Dr. Louise Ivers, who is heading up PIH’s cholera vaccination effort. This number doesn’t include cases seen by health workers in the villages and communities surrounding those cholera units.

Since October 2010, PIH has hired and trained over 3,300 community health workers to treat cholera using oral rehydration salts and teach people how to practice proper hygiene and sanitation. Staff has also been offering counseling to affected individuals, families and communities. Since August 2011, PIH’s psychosocial and mental health team has provided services to over 4,300 families and dozens of communities.

At the local level, PIH is conducting an aggressive public hygiene education campaign that includes radio messages and community trainings. Internationally, staff continues to advocate for the long-term solutions including the creation of public water and sanitation systems.

“We in the development and humanitarian assistance field need to learn more about how to accompany our partners in Haiti over the long term,” said Farmer.

PIH to begin vaccination program in January 2012

PIH will introduce an oral cholera vaccine as part of a comprehensive package of prevention and treatment in January 2012.

“We need to bring every resource available to stop the epidemic,” said Farmer. “There's no argument that this wouldn't save many thousands of lives and prevent many, many times more new cases.”

“We are planning to vaccinate about 100,000 Haitians with a vaccine called Shanchol,” said Ivers. Shanchol – an effective oral cholera vaccine recently approved by the World Health Organization – costs $1.85/dose, with each recipient requiring two doses. “200,000 doses are currently available,” added Ivers. “We'll be working on this project in collaboration with GHESKIO, as well as with the Haitian Ministry of Health.”

“Campaign planning is already underway, including stakeholder meetings and meetings with local communities…to ensure that we can have a communications campaign that really makes sense to explain to everybody what the vaccine is, how effective it is, what it means for them,” continued Ivers. “And our intention is that this would just be the beginning of a larger national campaign to include cholera vaccination as part of national protocols to control the epidemic.”

This oral cholera vaccination is nearly 70 percent effective and protects recipients for upwards of 36 months. Additional community protection would occur when a substantial portion of the population is vaccinated, added Ivers. It is estimated that 10 percent coverage would avert 63,000 cases and 900 deaths in Haiti, while 30 percent coverage would lead to a 55 percent reduction in cases, potentially saving thousands of lives.

Working with GHESKIO, a longtime partner based in Port-au-Prince, and Haiti’s Ministry of Health, PIH’s pilot vaccination campaign will target vulnerable populations in both Port-au-Prince and rural communities on the banks of the Artibonite River near the town of St. Marc, where the outbreak first began.

Number of NGOs treating cholera quickly diminishing

“128 NGOs and governmental organizations were working with cholera at the start of 2011,” said Donna Barry, PIH’s director of policy and advocacy. “And that number has now decreased to around 40.” A primary reason behind this pullout is decreased funding and the shifting interests and capabilities of organizations working on the ground.

Funding for programs across Haiti is not meeting the needs, putting reconstruction efforts at risk. “In 2010 and 2011, about $4.6 billion was pledged for recovery efforts in Haiti,” continued Barry. “Of that, 43 percent has been disbursed, which means that there's 57 percent left. We're in mid-October, with only 2 and a half months left in 2011, and 57 percent of that money is yet to be disbursed.”

These decreases are already having a major impact. A new report put out by the UN Office for the Coordination of Humanitarian Affairs (OCHA) finds that the number of people who have access to clean drinking water in Port-au-Prince’s settlement camps for persons displaced by the earthquake has decreased drastically since March, falling from 48 percent to 7 percent.

In March, 20 percent of people living in the camps had access to hand-washing stations. That number had dropped to 12 percent by August. Currently only 38 percent of these people have access to functioning latrines.

The situation is not much better outside of Port-au-Prince. OCHA finds that only 54 percent of Haitians have access to safe drinking water, while a shockingly low 30 percent have access to proper sanitation facilities. Access to clean drinking water is a basic human right; PIH urges the international community to do more to support the building of new water and sanitation infrastructure.